AED – Medical Schools and Humanities
July 30 , 2010
From the Friday, July 30 AMA Member Communications
(Source on Dr. Bashian’s computer: MSN/VCU – Medical Humanism/ July 30, 2010)
On its front page, the New York Times (7/30/10, A1, Hartocollis) reports, "For decades,
the medical profession has debated whether pre-med courses and admission tests produce
doctors who know their alkyl halides but lack the sense of mission and interpersonal
skills to become well-rounded, caring, inquisitive healers." Now, "that debate is being
rekindled by a study published on Thursday in Academic Medicine, the journal of the
Association of American Medical Colleges." This "peer-reviewed study compared
outcomes for 85 students in the" Mount Sinai Medical School's "Humanities and
Medicine Program with those of 606 traditionally prepared classmates from the
graduating classes of 2004 through 2009, and found that their academic performance in
medical school was equivalent."
The New York Times article is at
http://www.nytimes.com/2010/07/30/nyregion/30medschools.html?_r=1&adxnnl=1&part
ner=rss&emc=rss&adxnnlx=1280502002-ikJBNIpd10Ft1mjlOo5BYQ , and follows:
Below that is the link to the article from Mt. Sinai:
(http://journals.lww.com/academicmedicine/Fulltext/2010/08000/Challenging_Traditiona
l_Premedical_Requirements_as.26.aspx ).
_______________________________________________________________________
Getting Into Med School Without Hard
Sciences
By ANEMONA HARTOCOLLIS
Published: July 29, 2010 – N. Y. Times,
http://www.nytimes.com/2010/07/30/nyregion/30medschools.html
For generations of pre-med students, three things have been as certain as death and taxes:
organic chemistry, physics and the Medical College Admission Test, known by its dread-
inducing acronym, the MCAT.
So it came as a total shock to Elizabeth Adler when she discovered, through a singer in
her favorite a cappella group at Brown University, that one of the nation's top medical
schools admits a small number of students every year who have skipped all three
requirements.
Until then, despite being the daughter of a physician, she said, "I was kind of thinking
medical school was not the right track for me."
Ms. Adler became one of the lucky few in one of the best kept secrets in the cutthroat
world of medical school admissions, the Humanities and Medicine Program at the Mount
Sinai medical school on the Upper East Side of Manhattan.
The program promises slots to about 35 undergraduates a year if they study humanities or
social sciences instead of the traditional pre-medical school curriculum and maintain a
3.5 grade-point average.
For decades, the medical profession has debated whether pre-med courses and admission
tests produce doctors who know their alkyl halides but lack the sense of mission and
interpersonal skills to become well-rounded, caring, inquisitive healers.
That debate is being rekindled by a study published on Thursday in Academic Medicine,
the journal of the Association of American Medical Colleges. Conducted by the Mount
Sinai program's founder, Dr. Nathan Kase, and the medical school's dean for medical
education, Dr. David Muller, the peer-reviewed study compared outcomes for 85 students
in the Humanities and Medicine Program with those of 606 traditionally prepared
classmates from the graduating classes of 2004 through 2009, and found that their
academic performance in medical school was equivalent.
"There's no question," Dr. Kase said. "The default pathway is: Well, how did they do on
the MCAT? How did they do on organic chemistry? What was their grade-point
average?"
"That excludes a lot of kids," said Dr. Kase, who founded the Mount Sinai program in
1987 when he was dean of the medical school, and who is now dean emeritus and a
professor of obstetrics and gynecology. "But it also diminishes; it makes science into an
obstacle rather than something that is an insight into the biology of human disease."
Whether the study's findings will inspire other medical schools to change admissions
requirements remains to be seen.
Because MCAT scores are used by U.S. News and World Report and others to rank
schools, the most competitive ones fear dropping the test, admissions officials said. And
at least two recent studies found that MCAT scores were better than grade-point averages
at predicting performance in medical school and on the series of licensing exams that
medical students and doctors must take.
"You have to have the proper amount of moral courage to say 'O.K., we're going to skip
over a lot of the huge barriers to a lot of our students,' " said Dr. David Battinelli, senior
associate dean for education at Hofstra University School of Medicine.
But, Dr. Battinelli added, "Now let's see how they're doing 5 and 10 years down the
road." The Mount Sinai study did not answer the question.
There are a few other schools in the United States and Canada that admit students without
MCAT scores, but Mount Sinai appears to have gone furthest in eschewing traditional
science preparation, said Dr. Dan Hunt, co-secretary of the Liaison Committee on
Medical Education, the medical school accrediting agency.
The students apply in their sophomore or junior years in college and agree to major in
humanities or social science, rather than the hard sciences. If they are admitted, they are
required to take only basic biology and chemistry, at a level many students accomplish
through Advanced Placement courses in high school.
They forgo organic chemistry, physics and calculus - though they get abbreviated organic
chemistry and physics courses during a summer boot camp run by Mount Sinai. They are
exempt from the MCAT. Instead, they are admitted into the program based on their high
school SAT scores, two personal essays, their high school and early college grades and
interviews.
The study found that, by some measures, the humanities students made more sensitive
doctors: they were more than twice as likely to train as psychiatrists (14 percent
compared with 5.6 percent of their classmates) and somewhat more likely - though less
so than Dr. Kase had expected - to go into primary care fields, like pediatrics and
obstetrics and gynecology (49 percent compared with 39 percent). Conversely, they avoid
some fields, like surgical subspecialties and anesthesiology.
But what surprised the authors the most, they said, was that humanities students were
significantly more likely than their peers to devote a year to scholarly research (28
percent compared with 14 percent). They scored lower on Step 1 of the Medical
Licensing Examination, taken after the second year of medical school, which generally
correlates with scientific knowledge. But over all, they ranked about the same in honors
grades and in the percentage in the top quarter of the class.
Humanities students were also more likely to take a leave of absence for personal
reasons, which could reflect some ambivalence about their choices, the study authors
said.
Typically, 5 percent to 10 percent of the class drops out before getting to medical school.
Those students cannot handle the science or they have changed their minds about their
intention to be a doctor, said Miki Rifkin, the program director. One who dropped out
was Jonathan Safran Foer, who became an acclaimed novelist.
Dr. Kase founded the Mount Sinai program shortly after a national report on physician
preparation questioned the single-minded focus on hard science.
He began with a few students from five colleges and universities that did not have their
own medical schools - Amherst, Brandeis, Princeton, Wesleyan and Williams - because,
he said, "we did not want to poach."
It has been going full tilt for the past 10 years, and received nearly 300 applications last
year from more than 80 colleges across the country, though admissions heavily favor elite
schools.
Among undergraduates accepted in 2009, the mean SAT math and verbal score was
1444, and the mean freshman G.P.A. was 3.74. About a third of the class had at least one
parent who was a physician; among all medical schools, about one in five has a parent
who is a doctor.
Among the current crop is Ms. Adler, 21, a senior at Brown studying global political
economy and majoring in development studies.
Ms. Adler said she was inspired by her freshman study abroad in Africa. "I didn't want to
waste a class on physics, or waste a class on orgo," she said. "The social determinants of
health are so much more pervasive than the immediate biology of it."
She added that her parents, however, were "thrilled when I decided to go the M.D. route,
because they were worried about my job security."
A classmate in the program, Kathryn Friedman, 21, graduated from the Chapin School in
New York City, before going to Williams, where she is a senior, majoring in political
science. Her mother and uncle are doctors at Mount Sinai; her father, Robert Friedman,
who works in the entertainment business, is on the Mount Sinai Medical Center board.
The humanities program has allowed her to pursue other interests, like playing varsity
tennis and going abroad, she said. When her pre-med classmates hear about the program,
she said, "a lot of them are jealous."
She added, "They are, like, 'Wow, I wish I had known about that.' "
This article has been revised to reflect the following correction:
SOURCE ARTICLE
Academic Medicine:
August 2010 - Volume 85 - Issue 8 - pp 1378-1383
doi: 10.1097/ACM.0b013e3181dbf22a
Premedical Requirements
Internet Site:
http://journals.lww.com/academicmedicine/Fulltext/2010/08000/Challenging_T
raditional_Premedical_Requirements_as.26.aspx